Practice Management Alert

Question: Our doctor saw a patient in the emergency room and decided to admit him and perform surgery. This patient is not Medicare. Do I code this using 99221-99223, as an outpatient E/M code, or with an emergency room E/M code? Also do I need to add a modifier if our doctor is the admitting physician?Missouri Subscriber Answer: You should use 99221-99223 (Initial hospital care ...), assuming that your surgeon's documentation will support the code. Once the patient is in inpatient status (per the hospital), you can no longer use outpatient codes.Since this is not a Medicare patient, you do not need a modifier unless your physician is taking the patient to the operating room or going to do a minor procedure. If he takes the patient to the operation room, append modifier 57 (Decision for surgery). For a minor procedure, use modifier 25 (Significant, separately identifiable evaluation and management [...]